• Journal of Chest Surgery
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• v.56 no.6
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• pp.452-455
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• 2023

Patients who have undergone mechanical valve replacement require anticoagulation therapy with warfarin to prevent thromboembolism. However, administering warfarin to pregnant patients increases their risk of warfarin embryopathy or central nervous system disorders. Consequently, safer alternatives, such as heparin or low-molecular-weight heparin injection, are substituted for warfarin. However, limited research has been conducted on this subject, with no large-scale studies and particularly few investigations involving multiparous patients. A patient who had previously undergone mechanical mitral valve replacement for atrial septal defect and mitral stenosis received anticoagulant therapy with enoxaparin during 2 pregnancies. Upon confirmation of pregnancy, warfarin was replaced with subcutaneously injected enoxaparin with a dosage of 1 mg/kg at 12-hour intervals. The enoxaparin dosage was controlled using an anti-factor Xa assay, with a target range of 0.3-0.7 IU/mL. Intravenous heparin injections were administered starting 3 days prior to the expected delivery date and were continued until delivery, after which warfarin was resumed. No complications were observed during the deliveries.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.4
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• pp.423-426
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• 2023

Backgrounds/Aims: Patients who undergo pancreatic surgery with venous resection have high rates of morbidity/mortality. Also, they are high-risk for postoperative venous thromboembolism. Whether this group should be routinely anticoagulated is unknown. This study aimed to establish current anticoagulation practices. Methods: A survey (https://form.jotform.com/220242489107048) was sent out to pancreatic surgeons. Questions covered center volume, venous resection/reconstruction techniques and anticoagulation policies. Results: Sixty-five centers from 17 countries responded. Following a "side-bite" venous resection with a patch repair, 40% used an autologous vein patch, 27% used peritoneum, and 27% used a bovine patch. After formally resecting a segment of vein, 17% of centers used an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (73%) grafts were the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a "side-bite" resection, 59%, 28%, and 19% of centers provided therapeutic anticoagulation, respectively (66% used low molecular-weight heparin). The duration of therapy provided varied from inpatient stay only (14%) to six months (32%). Conclusions: Our global survey indicates that anticoagulation practices are highly variable. Centers do not agree on when to anticoagulate, how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.2
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• pp.204-209
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• 2022

The state of intense peripancreatic inflammation in chronic pancreatitis can give rise to various vascular complications such as venous thrombosis and arterial pseudoaneurysms. Due to its intimate location with the pancreas, spleno-mesenteric-portal axis suffers the greatest blunt of thrombotic complications. Treatment modalities for such cases of chronic portal vein thrombosis have always been controversial and challenging. Medical management with anticoagulants is both risky and unsatisfactory due to presence of varices, hypersplenism, and persistence of the inflammatory pathology. Although endovascular techniques have been tried in various case reports, there are definite anatomical challenges in cases of long segment porto-mesenteric thrombosis with massive ascites. Surgical shunts have been historically described for cirrhotic and non-cirrhotic portal hypertensive patients. However, its use in patients with refractory ascites due to chronic pancreatitis induced portal vein thrombosis has not been reported in the medical literature. Here, we present a case of an extensive portal vein thrombosis with massive refractory ascites in a patient with alcohol-induced chronic pancreatitis successfully treated with a surgical mesocaval shunt using an interposition small diameter graft.

• Korean Journal of Veterinary Service
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• v.22 no.4
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• pp.377-383
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• 1999

Polymorphonuclear (PMN) leucocytes are fundamental importance to the body's defense mechanism and play a major role in the local and systemic reactions to infectious disease. Investigation of the physiological and pathological role of the various leucocyte subtypes in host defence mechanisms is dependent upon the isolation of adequate numbers of viable, pure leucocyte fractions. This report describes the separate frequency of PMN leucocytes both from buffy coat layer and from packed RBC layer when bovine peripheral blood was treated with various anti-coagulants such as acid-citrate-dextrose(ACD), ethyldiaminetetraacetic acid(EDTA), sodium citrate and heparin. The separate frequencies of PMN leucocytes from buffy coat layer was 60.4$\pm$9.6%(heparin), 56.8$\pm$11.8%(sodium citrate), 30.6$\pm$14.1%(ACD) and 6.2$\pm$3.7%(EDTA), in order. Those from packed RBC layer monitored with EDTA, ACD, sodium citrate and heparin was 85.0$\pm$4.7%, 84.3$\pm$5.5%, 83.8$\pm$6.5% and 76.3$\pm$7.7%, respectively. The Ficoll-hypaque(FH) density gradient method was used to remove a small part of lymphocytes and/or monocytes from leucocytes in packed RBC layer. With the result that it increased separate frequency of PMN leucocytes from EDTA(89.9$\pm$2.4%), ACD(89.5$\pm$3.6%), and sodium citrate(83.6$\pm$10.3%) than heparin(68.4$\pm$13.9%). These results indicate that the use of EDTA and ACD as anticoagulant Is suitable for the separation of PMN leucocytes from bovine peripheral blood, and that the FH density gradient method is able to increase the separate frequency of PMN leucocytes from packed RBC layer.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.1010-1014
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• 2004

Though acute pulmonary thromboembolism is usually managed medically with the use of thrombolytics or anticoagulants, an emergent life-saving surgery would be required. In a case of acute pulmonary thromboembolism with acute severe right heart failure and deferment of it could result in fatal outcomes in a short time. In addition, the mortality is raised considerably if it is combined with right heart thrombi. Despite paradoxical thromboembolism via patent foramen ovale was reported, few report might be presented, in which showed the thrombus in right atrium has traversed atrial septal defect into left atrium and left ventricle like this case as the evidence of paradoxical thromboembolism. We report a case of acute pulmonary thromboembolism with acute right heart failure arising from deep vein thrombosis, developed immediately after low anterior resection for colon cancer in a 63-year-old male, who was managed successfully by emergent thromboembolectomy with cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.46 no.6
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• pp.413-425
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• 2013

Background: Graft vessel preservation solution in coronary artery bypass surgery is used to maintain the graft conduit in optimal condition during the perioperative period. Nafamostat mesilate (NM) has anticoagulation and anti-inflammatory properties. Therefore, we investigated NM as a conduit preservative agent and compared it to papaverine. Methods: Sprague-Dawley (SD) rat thoracic aortas were examined for their contraction-relaxation ability using phenylephrine (PE) and acetylcholine (ACh) following preincubation with papaverine and NM in standard classical organ baths. Human umbilical vein endothelial cells (HUVECs) were cultured to check for the endothelial cell viability. Histopathological examination and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed on the thoracic aortas of SD rats. Results: The anti-contraction effects of papaverine were superior to those of NM at PE (p<0.05). The relaxation effect of NM on ACh-induced vasodilatation was not statistically different from that of papaverine. Viability assays using HUVECs showed endothelial cell survival rates of >90% in various concentrations of both NM and papaverine. A histopathological study showed a protective effect against necrosis and apoptosis (p<0.05) in the NM group. Conclusion: NM exhibited good vascular relaxation and a reasonable anti-vasocontraction effect with a better cell protecting effect than papaverine; therefore, we concluded that NM is a good potential conduit preserving agent.

• Journal of Preventive Medicine and Public Health
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• v.53 no.1
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• pp.56-63
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• 2020

Objectives: The objective of this study was to determine the effect of atrial fibrillation (AF) on the risk of dementia in the Korean elderly. Methods: A 10-year retrospective cohort study was conducted using the National Health Insurance Service-Senior Cohort database. We excluded those who were under 65 years of age as of January 2006 (n=46 113), those who were diagnosed with dementia between 2002 and 2005 (n=9086), and those with a history of stroke prior to AF diagnosis (n=8392). We used a Cox proportional hazards model with a time-varying covariate to determine whether AF is associated with the risk of dementia after adjusting for potential confounders. Results: In univariable Cox regression, the hazard ratio (HR) of dementia according to AF status was 1.28 (95% confidence interval [CI], 1.23 to 1.33). After adjusting for potential confounders, AF was found to increase the risk of dementia (HR, 1.12; 95% CI, 1.07 to 1.17), Alzheimer dementia (HR, 1.12; 95% CI, 1.07 to 1.17), and vascular dementia (HR, 1.10; 95% CI, 1.03 to 1.18). In patients diagnosed with AF, the incidence of dementia was lower (HR, 0.50; 95% CI, 0.47 to 0.52) in patients who were treated with oral anticoagulants. Conclusions: Investigating the potential risk factors of dementia in an aged society is important. We found a slightly higher risk of dementia in those with AF than in those without AF, and we therefore concluded that AF is a potential risk factor for dementia.

• Parasites, Hosts and Diseases
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• v.55 no.4
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• pp.417-420
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• 2017

Hookworm infections are rare causes of acute gastrointestinal bleeding. We report a middle aged man with primary nephrotic syndrome and pulmonary embolism. During the treatment with steroids and anticoagulants, the patient presented acute massive hemorrhage of the gastrointestinal tract. The results of gastroscopy showed red worms in the duodenum. Colonoscopy and CT angiogram of abdomen were unremarkable. Capsule endoscopy revealed fresh blood and multiple hookworms in the jejunum and ileum. Hookworms caused the acute intestinal bleeding. The patient responded well to albendazole. Hematochezia was markedly ameliorated after eliminating the parasites. Hence, hookworm infection should be considered in the differential diagnosis of a patient with obscure gastrointestinal bleeding. Capsule endoscopy may offer a better means of diagnosis for intestinal hookworm infections.

• Journal of Chest Surgery
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• v.51 no.2
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• pp.114-121
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• 2018

Background: Unfractionated heparin is commonly used for anticoagulation in extracorporeal membrane oxygenation (ECMO). Several studies have shown that nafamostat mesilate (NM) has comparable clinical outcomes to unfractionated heparin. This study compared anticoagulation with NM and heparin in a large-animal model. Methods: Beagle dogs (n=8; weight, 6.5-9 kg) were placed on venovenous ECMO. Blood samples were taken every hour and the following parameters were compared: hemoglobin level, activated partial thromboplastin time (aPTT), thromboelastography (TEG) data, platelet function, and inflammatory cytokine levels. Results: In both groups, the aPTT was longer than the baseline value. Although the aPTT in the NM group was shorter than in the heparin group, the TEG parameters were similar between the 2 groups. Hemoglobin levels decreased in both groups, but the decrease was less with NM than with heparin (p=0.049). Interleukin $(IL)-1{\beta}$ levels significantly decreased in the NM group (p=0.01), but there was no difference in the levels of tumor necrosis factor alpha or IL-10 between the 2 groups. Conclusion: NM showed a similar anticoagulant effect to that of unfractionated heparin, with fewer bleeding complications. NM also had anti-inflammatory properties during ECMO. Based on this preclinical study, NM may be a good alternative candidate for anticoagulation in ECMO.

• Tuberculosis and Respiratory Diseases
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• v.67 no.4
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• pp.351-355
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• 2009

The incidence of pulmonary thromboembolism increases with age. The risk factors of pulmonary thromboembolism include surgery, malignancy, obesity, lupus anticoagulants, and vascular conditions such as deep vein thrombosis. Thromboembolism in younger patients or in unusual locations, the possibility of primary thrombophilic conditions should be considered. Primary thrombophilic states include myeloproliferative disorders (MPD). JAK2 V617F mutation is found commonly in patients diagnosed with MPD, in 90~95% of polycythemia vera (PV) and in 50~60% of essential thrombocytosis (ET) patients. Sometimes the JAK2 V617F mutation is found in cases without MPD. The relationship between JAK2 V617F mutation and thrombosis has not been defined. Recently, clinical evidence suggests that this mutation may be variably associated with thrombosis. We present one case of pulmonary thromboembolism in a young patient, who was positive for the JAK2 V617F mutation and did not have MPD.